LECTURER, DEPARTMENT OF OBSTETRICS & GYNAECOLOGY, SCHOOL OF MEDICAL SCIENCES
UNIVERSITI SAINS MALAYSIA
Lecturer, Obstetrician & Gynaecologist, Universiti Sains Malaysia,
Kubang Kerian, Kelantan
Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
E-mail: enhusna@ drengkuhusna@
Year Degree/Qualification Discipline University/Institute
2011 Doctor of Medicine (MD) Medicine & Surgery Universiti Malaysia Sabah
2019 Master of Medicine (MMED) Obstetrics & Gynaecology Universiti Sains Malaysia
OBSTETRICS & GYNAECOLOGY, FETOMATERNAL MEDICINE, HIGH-RISK PREGNANCY, LABOUR ROOM MANAGEMENT
Nuchal cord occurs when the umbilical cord becomes wrapped around the fetal neck 360 degrees. Nuchal cord occur in about 10–29% of fetuses, and the incidence increases with advancing gestation age. Most are not associated with perinatal morbidity and mortality. Still, a few studies have shown that nuchal cord can affect the outcome of delivery with possible long-term effects on the infants. Nuchal cord more likely to cause problems when the cord is tightly wrapped around the neck, with results of a tight nuchal cord conceptually similar to strangulation. Umbilical cord compression due to tight nuchal cord may cause obstruction of blood flow in thin-walled umbilical vein, while infant’s blood continues to be pumped out of the baby through the thicker-walled umbilical arteries causing hypovolemia, acidosis and anaemia. Some of these infants have physical features secondary to tight nuchal cords that are distinct from those seen with birth asphyxia. The purpose of this article is to review the pathophysiology of tight nuchal cord and explore gaps in knowledge and research areas.
Siti Fatimah Abdul Halim, Zulkarnay Zakaria, Jaysuman Pusppanathan, Anas Mohd Noor, Ahmad Nasrul Norali, Mohd Hafiz Fazalul Rahiman, Siti Zarina Mohd Muji, Ruzairi Abdul Rahim, Engku Ismail Engku-Husna, Muhamad Khairul Ali Hassan,et al. MDPI AG
Fetal acidosis is one of the main concerns during labor. Currently, fetal blood sampling (FBS) has become the most accurate measurement of acidosis detection. However, it is invasive and does not provide a real time measurement due to laboratory procedures. Delays in diagnosis of acidosis have caused serious injury to the fetus, especially for the brain and the heart. This paper reviews the new technique in diagnosis of acidosis non-invasively. Magnetic Induction Spectroscopy (MIS) has been proposed to be a new device for acidosis detection in recent years. This paper explains the basic principle of MIS and outlines the design specifications and design considerations for a MIS pH probe. It is expected that readers will gain a basic understanding of the development of a MIS pH probe from this review.
Engku Ismail Engku-Husna, Nik Lah Nik-Ahmad-Zuky, and Kadir Muhammad-Nashriq Springer Science and Business Media LLC
Abstract Background Müllerian duct anomaly is a rare condition. Many cases remain unidentified, especially if asymptomatic. Thus, it is difficult to determine the actual incidence. Müllerian duct anomaly is associated with a wide range of gynecological and obstetric complications, namely infertility, endometriosis, urinary tract anomalies, and preterm delivery. Furthermore, congenital anomalies in pregnant mothers have a high risk of being genetically transmitted to their offspring. Case presentation We report a case of a patient with unsuspected müllerian duct anomaly in a term pregnancy. A 33-year-old Malay woman with previously uninvestigated involuntary primary infertility for 4 years presented with acute right pyelonephritis in labor at 38 weeks of gestation. She has had multiple congenital anomalies since birth and had undergone numerous surgeries during childhood. Her range of congenital defects included hydrocephalus, for which she was put on a ventriculoperitoneal shunt; imperforated anus; and tracheoesophageal fistula with a history of multiples surgeries. In addition, she had a shorter right lower limb length with limping gait. Her physical examination revealed a transverse scar at the right hypochondrium and multiple scars at the posterior thoracic region, levels T10–T12. Abdominal palpation revealed a term size uterus that was deviated to the left, with a singleton fetus in a nonengaged cephalic presentation. The cervical os was closed, but stricture bands were present on the vagina from the upper third until the fornices posteriorly. She also had multiple rectal prolapses and strictures over the rectum due to previous anorectoplasty. An emergency cesarean delivery was performed in view of the history of anorectoplasty, vaginal stricture, and infertility. Intraoperative findings showed a left unicornuate uterus with a communicating right rudimentary horn. Conclusion Most cases of müllerian duct anomaly remain undiagnosed due to the lack of clinical suspicion and the absence of pathognomonic clinical and radiological characteristics. Because it is associated with a wide range of gynecological and obstetric complications, it is vital for healthcare providers to be aware of its existence and the role of antenatal radiological investigations in its diagnosis. The presence of multiple congenital abnormalities and a history of infertility in a pregnant woman should warrant the exclusion of müllerian duct anomalies from the beginning. Early detection of müllerian duct anomalies can facilitate an appropriate delivery plan and improve the general obstetric outcome.
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2. Joo LS, Ismail EHE, Ismail MP, Mahmood NMZN, Adnan WFW, Sung HP. Understanding the Behaviour of a Low-Grade Serous Carcinoma. Edorium J Gynecol Obstet 2019;5:100023G06LJ2019.